AACOM: Inside OME

This story was originally published in Inside OME, the newsletter of the American Association of Colleges of Osteopathic Medicine.

While it is well known that health professionals need the cultural sensitivities to understand and competencies to care for all U.S. populations, a disconnect remains when it comes to effectively meeting the unique health needs of our nation’s veterans and military service members.

Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) faculty members have undertaken the mission to bridge this gap.

Media in Medicine

Todd Fredricks, DO, Assistant Professor of Family Medicine and Army National Guard Officer, and Brian Plow, Associate Professor and Associate Director for Undergraduate Studies in the Scripps College of Communication, joined forces to create Media in Medicine, a collaborative effort between students and faculty of OU-HCOM and Scripps College of Communication’s School of Media Arts and Studies on innovative teaching and research projects in media, communication, and medicine.

Set for January 2017 release, Media in Medicine presents its flagship endeavor, “The Veterans’ Project,” a documentary that aims to bring physicians and the American public closer to the individual voices of veterans of all ages as they return to civilian life.

Shifting Focus

Dr. Fredricks’ research found that many physicians feel uncomfortable or unfamiliar dealing with health-related exposures and risks that veterans might experience. The documentary aims to serve as an educational tool to help student doctors better understand the unique health care needs of this population.

While Dr. Fredricks’ research was presented at professional conferences and published in a medical journal, he knew that his reach was limited. He wanted to create a larger impact and connect with medical students and physicians who needed to hear it most—our future health care providers—with a more relevant and engaging approach.

“My perspective on the health of veterans allows me to introduce the mechanism for rebuilding some of the broken bridges,” said Dr. Fredricks. “Brian’s understanding of how to create a film and story arc reinforces that effort. Together our team becomes synergistic in the effort.”

This is where the idea of a documentary came into focus—the opportunity to do the film from a medical research perspective.

One soldier. One voice. One story at a time.

“You can do legitimate research in a beautiful way,” Dr. Fredricks says. “The elegance of the format can help build knowledge.”

While Dr. Fredricks recognizes the role of published peer reviewed research in academics and education, “I will be the first to say that and defend that, but visual and auditory story telling is far more powerful in affecting people,” he says.

“There needs to be an emotional component, a buy-in, for people to change their behavior. Film allows that and in fact promotes that. These are real people and real stories, and because of that, they have the power to affect the physicians and nurses and social workers that watch them in a way that we hope will pique curiosity and prompt those professionals to engage in greater inquiry with this population.”

When asked about the inspiration behind the documentary, and the drivers behind putting the idea into action, Dr. Fredricks spoke to the motivators to the creation of “The Veterans Project”:

One of the first was my experiences in the VA. I worked for them for two and a half years, and during that time, I saw some incredibly devoted people working for the benefit of veterans […]. The VA tends to be very insular but the problem with that is that most veterans do not get their care from the VA, and if they do, they receive care only for service connect issues and not comprehensive care. This leads to fragmentation of care and ends up sometimes being a big mess for the veteran.

The second big motivator for me was a veteran that I have taken care of for years on the aerospace medicine side of things. This particular veteran had a very uncomfortable encounter with a civilian physician who assumed that he was seeking narcotics when he was not.

Finally, a piece written for the New York Times by Karl Eikenberry and David Kennedy really hit home for me. As a 25-year U.S. Army Veteran, I have been deeply concerned by the separation of the U.S. civilian population and the U.S. military. The failure to understand the U.S. military and what it does has ramifications that are not good.

Asking the Right Questions

Throughout this process, Dr. Fredricks and Plow shed light on common issues that veterans face. As for the veterans’ interactions with the health care system, Dr. Fredricks said that the most common theme that they see are false assumptions on the part of clinicians.

“If we teach people to ask the right questions, maybe we will get better care as an outcome,” said Dr. Fredricks.

From a medical education perspective, Dr. Fredricks explains:

I can think of nothing more rewarding as an educator than to be a conduit for young medical students seeking to work with veterans or pursue training in the VA.

Veterans are an interesting patient population in that they tend to be very transparent once trust is gained. Most veterans just want to be as functional as possible in life so they can keep moving.

We have an incredible team of excited and motivated people at OU-HCOM and Scripps who are working to support the implementation of this project. I suspect that there will be interest in using it as a cross-cultural training tool. We will see. As of yet, we have no other schools expressly interested but I feel that this will change once we publish our findings and get the training package validated.

The duo also sees potential in teaching their research and documentary process to others so that medical schools could use it for outreach and education for variety of medical matters.

When asked whether he was surprised by any results of the research project, Dr. Fredricks told us:

In general, my research validates what I already intuitively know: U.S. civilians don’t know much about their veterans. This is also the case with civilian physicians. So I am not surprised by much of our findings.

We have 20 million living U.S. veterans and our “man-on-the-street” interviews have shown that some Americans think this number is as few as 50,000. Which is amazing to me since something over 2.8 million have been to Afghanistan and Iraq alone.

However, Dr. Fredricks found himself to be pleasantly surprised from this experience in other ways.

One of the things that has affected me has been the number of people who are excited about this topic and want to help us get it into the pipeline. Every researcher is connected to and thinks their own research is the most important out there. I get that and I am also realistic about the fact that just a few people will ever read what I publish. But when I show clips to our team members (and they are now approaching 100 in total) and I see their reaction to the work it amazes me that an idea can motivate people and generate reactions—emotional reactions that I did not anticipate.

I am very close to this work. I have seen soldiers pulled off the helicopter in Balad and taken to the Combat Support Hospital and I have loaded patients onto helicopters who have been hurt badly so I can tell you that listening to someone like Raul Marin, MD, speak about his devotion to the injured hits something really deep within me.

But does it affect those who are 8,000 miles removed from those events? I have to say that finding out that it does was surprising to me.

Finally, Dr. Fredricks reflected on what he hopes to see as a result of their work:

The result of The Veterans’ Project specifically for me is that every medical professional knows to ask three specific questions with every new patient and ultimately knows how to respond to the answer that they receive. To have viewers of this work tell us that they no longer take veterans for granted but truly are interested in getting to know them as people and hear about what they have done in the service of their country would be the best thing I could imagine for this project.

In the future I would like to see The Veterans’ Project as an exportable learning package that any institution can show to their students and start the process of getting those people to engage with and activate veterans to achieve better integration of their care.